Healthcare Provider Details

I. General information

NPI: 1942678099
Provider Name (Legal Business Name): STEPHANIE ELYSE LLANES RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 SW 36TH ST STE 9
DAVIE FL
33328-1915
US

IV. Provider business mailing address

12771 SW 104TH AVE
MIAMI FL
33176-4764
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-7790
  • Fax: 954-577-7780
Mailing address:
  • Phone: 305-431-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36273
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: